“For many years, Americans have been dying at younger ages than people in almost all other high-income countries,” according to a report from the National Research Council and the Institute of Medicine just released in January 2013. The US health disadvantage is reflected in a reduced life expectancy by as much as 3-5 years depending on the comparison population, and in nine health domains.

Tragedy

The committee said that the strength of their findings surprised them and stated “this health disadvantage is particularly striking given the wealth and assets of the United States and the country’s enormous level of per capita spending on health care, which far exceeds that of any other country.” In an online video, the Committee chair, Steven Wolff from Virginia Commonwealth University, called the health disadvantage a “tragedy” because international comparisons show better health exists elsewhere and therefore could be achieved for US residents as well.

Previous Work

The Committee undertook its work at the request of NIH after an earlier NRC report in 2011 found a mortality gap among US adults age 50 and older. This second report in 2013 was commissioned to determine if the health disadvantage for adults 50 and older existed at earlier ages as well. It does, and begins at birth, the committee found. It compared the health of US residents to that of persons in 16 other high-income or “peer” countries, including Australia, Austria, Canada, Denmark, Finland, France, Germany, Italy, Japan, Norway, Portugal, Spain, Sweden, Switzerland, the Netherlands, and the United Kingdom. It documented the age-adjusted death rates per 100,000 population for more than 50 different health outcomes.

Problem Areas

On the basis of these rate comparisons, the Committee found that the US fares worse in nine health domains including birth outcomes (highest infant mortality, poor ranking for low birth weight), injuries and homicides (motor vehicle crashes, violence), pregnancy and sexually transmitted diseases among adolescents, HIV and AIDS, alcohol and other drugs, obesity and diabetes, heart disease, chronic lung disease, and arthritis and activity limitations.

According to the Committee, deaths that occur before age 50 are responsible for about two-thirds of the difference in life expectancy between males in the US and peer countries, and about one-third of the difference for females.

Also, the Committee found that the health disadvantage is more pronounced among lower socioeconomic groups, but the disadvantage exists for persons more well-off when compared to similar groups in the peer countries.

Explanations

 The Committee was also charged with exploring potential explanations for the pervasive health disadvantage and concluded that despite the existence of many differences between the US and peer countries, “no single factor fully explains the US health disadvantage.” However, struck by the pervasive nature of the disadvantage on measures of health, access to care, individual behaviors, child poverty, and social mobility, the Committee “considered” the possibility that there might be a common denominator running through the multiple domains of US health disadvantage.

Common Denominator?

 What could that common denominator be? The Committee came to no clear conclusion, but stated “because choices about political governance structures, and the social and economic conditions they reflect and shape, matter to overall levels of health, the panel asked whether some of these underlying societal factors could be contributing to greater disease and injury rates and shorter lives in the United States.”

Recommendations

 The Committee made three recommendations pertaining to research and three pertaining to policy.

On the research side, the Committee called for improvements in the quality and consistency of data sources available for cross-national data comparisons, the development of more refined analytic methods and study designs for cross-national health research, and coordinated funding for investigator-initiated research on the potential causes and potential solutions for the US health disadvantage.

Policy Side

 On the policy side, the Committee called for intensifying efforts to meet health objectives using effective strategies directed at specific health disadvantages, informing the general public and stimulating a national conversation, and for an analytic review of the evidence on the role of policies in different domains in

impacting health. If policies are found to be consequential in affecting health, these then could explain some of the cross-national differences.

The Committee concluded “With so much at stake, especially for America’s youth, the United States cannot afford to ignore its growing health disadvantage.” Barbara Rimer, the dean of the UNC Gillings School of Public Health commented about this report on her blog. She told readers, “I’m appalled that with all the resources we have in this country we should end up at the bottom for many of these critical health indicators. We know a lot about how to raise ourselves up. And people in public health can help. We’ve got a lot of work to do. We can do better.”

A copy of the report entitled “US Health in International Perspective: Shorter Lives, Poorer Health” can be downloaded at:

http://tinyurl.com/bgef3qu

Interactive Graphs

Also, the Committee has made available an interactive set of graphs of mortality rates in all 17 countries for over 50 different health outcomes. Readers can click on a specific condition or a category of conditions such as communicable diseases, injuries, or non-communicable diseases and immediately view a table showing the rates and rankings for all 17 peer countries for that variable. Passing the mouse over each of the 17 lines on the graph will reveal the actual age adjusted number of deaths. To access the interactive graphs, visit:
http://tinyurl.com/aw77tcz

Also, to view a video presentation by Dr Wolff on the major findings of the report, readers can visit:
http://tinyurl.com/auc472a

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